NSG 550 Exams 1–3 – Wilkes Diagnostic Reasoning: 250-Question Practice Bank

NSG 550 Exams 1–3 – Wilkes Diagnostic Reasoning: 250-Question Practice Bank 1. A 68-year-old male with a history of benign prostatic hyperplasia presents for his annual physical. His provider orders a PSA level. The nurse understands that an elevated PSA is most specific for which of the following conditions? A. Urinary tract infection B. Prostate cancer C. Acute kidney injury D. Bladder obstruction Answer: B. Prostate cancer 2. A nurse is reviewing the diagnostic workup for a patient suspected of having rheumatoid arthritis. Which laboratory tests should the nurse anticipate the provider will order? Select all that apply. A. Rheumatoid Factor (RF) B. Anti-CCP antibody C. C-reactive Protein (CRP) D. Erythrocyte Sedimentation Rate (ESR) E. Complete Blood Count (CBC) Answer: A, B, C, D, E 3. A patient is scheduled for a bone scan using a radioactive isotope. Which pre-procedure instruction should the nurse provide? A. "You will need to fast for 12 hours before the scan." B. "Remove all metal jewelry and clothing with zippers before the procedure." C. "You will be radioactive for several weeks and must avoid contact with others." D. "Drink only clear fluids for 48 hours after the injection." Answer: B. "Remove all metal jewelry and clothing with zippers before the procedure." 4. A 45-year-old female presents with fatigue, weight gain, constipation, and bradycardia. Laboratory studies reveal elevated TSH and low T3 and T4 levels. The nurse recognizes these findings are consistent with which condition? A. Hyperthyroidism B. Hypothyroidism C. Cushing's syndrome D. Addison's disease Answer: B. Hypothyroidism 5. A patient with type 1 diabetes presents to the emergency department with fruity breath, Kussmaul respirations, and altered mental status. Laboratory results show high ketones, high anion gap, low potassium, and rising BUN/creatinine. The nurse recognizes these findings as indicative of: A. Hyperosmolar hyperglycemic state B. Diabetic ketoacidosis (DKA) C. Hypoglycemic shock D. Acute kidney injury Answer: B. Diabetic ketoacidosis (DKA) 6. A nurse is caring for a patient who underwent a cystoscopy. Which statement by the patient indicates a need for further teaching? A. "I may notice some pink-tinged urine after the procedure." B. "I should drink plenty of fluids to flush my bladder." C. "I can resume my normal diet immediately after the procedure." D. "I should report burning with urination that lasts more than 24 hours." Answer: C. "I can resume my normal diet immediately after the procedure." 7. A 52-year-old male presents to the emergency department with sudden onset of severe epigastric pain that radiates to his back. He reports nausea and vomiting. The pain is steady and worsens when he walks or lies supine. He admits to drinking approximately 12 beers daily and consumed a large fatty meal 4 hours prior to symptom onset. His vital signs reveal a temperature of 101.2°F, heart rate of 112 bpm, and blood pressure of 148/92 mmHg. Laboratory studies show lipase 980 U/L (normal: 10–140), amylase 420 U/L (normal: 30–110), ALT 85 U/L, CRP 18 mg/L, WBC 16,500/µL, and glucose 198 mg/dL. Which diagnostic imaging study is the first choice to confirm the diagnosis? A. Abdominal ultrasound B. CT abdomen with contrast C. MRI abdomen D. ERCP Answer: B. CT abdomen with contrast 8. A 45-year-old female presents with RUQ pain, nausea, vomiting, and a low-grade fever. She reports the pain began approximately 6 hours after eating fried chicken. On physical examination, the nurse practitioner elicits a positive Murphy's sign. Her WBC is 14,200/µL. Which of the following diagnostic tests would be appropriate to order? Select all that apply. A. RUQ ultrasound B. HIDA scan C. CT abdomen D. ERCP E. Abdominal x-ray Answer: A, B 9. A 68-year-old male with a history of alcohol abuse presents with epigastric pain, nausea, and vomiting. Laboratory studies reveal a lipase of 1,250 U/L (3× upper limit of normal) and an amylase of 380 U/L. The nurse practitioner knows that lipase is more sensitive and specific than amylase for pancreatitis. Which statement about these laboratory findings is most accurate? A. Amylase remains elevated longer than lipase and is therefore more useful for late diagnosis. B. Lipase remains elevated longer than amylase and is the preferred diagnostic marker. C. Both enzymes normalize within 24 hours, so serial testing is not useful. D. ALT elevation is the most specific indicator of pancreatitis. Answer: B. Lipase remains elevated longer than amylase and is the preferred diagnostic marker. 10. A 35-year-old male presents with periumbilical pain that has migrated to the RLQ over the past 12 hours. He reports nausea, a low-grade fever of 100.8°F, and rebound tenderness at McBurney's point. Which diagnostic findings and physical examination signs are consistent with acute appendicitis? Select all that apply. A. Rovsing's sign B. Psoas sign C. Murphy's sign D. McBurney's point tenderness E. Positive obturator sign Answer: A, B, D, E